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Robotic-assisted laparoscopic surgery for complex hepatolithiasis: a propensity score matching analysis.

Jie Shu1, Xiao-Jun Wang1, Jian-Wei Li1

  • 1Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), 30 Gaotanyan Main Street, Shapingba District, Chongqing, 400038, China.

Surgical Endoscopy
|October 24, 2018
PubMed
Summary

Robotic-assisted laparoscopic surgery (RLS) is a safe and effective treatment for complicated hepatolithiasis, offering reduced blood loss and shorter hospital stays compared to open surgery (OS). This approach demonstrates significant advantages in patient recovery.

Keywords:
HepatolithiasisLaparoscopyLiver resectionMinimally invasive surgeryPSMRobotic

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Area of Science:

  • Hepatobiliary surgery
  • Minimally invasive surgery
  • Surgical robotics

Background:

  • Hepatolithiasis, or intrahepatic stones, traditionally requires open surgery (OS) for complex cases.
  • Laparoscopic approaches are limited in complex hepatolithiasis, but robotic-assisted laparoscopic surgery (RLS) offers enhanced visualization and dexterity.
  • RLS presents a theoretically advantageous alternative for complicated hepatolithiasis.

Purpose of the Study:

  • To evaluate the safety, efficacy, and feasibility of robotic-assisted laparoscopic surgery (RLS) for treating complicated hepatolithiasis.
  • To compare RLS with traditional open surgery (OS) in managing complex hepatolithiasis.

Main Methods:

  • A propensity score matching (PSM) analysis compared 26 patients undergoing RLS with 52 patients undergoing OS for complicated hepatolithiasis.
  • Patient demographics, stone characteristics, liver function, and surgical outcomes were analyzed.
  • Follow-up data assessed stone recurrence and recurrent cholangitis.

Main Results:

  • No significant differences were observed in postoperative complication rates, intraoperative, or final stone clearance between RLS and OS groups.
  • The RLS group exhibited significantly less blood loss, lower transfusion rates, shorter oral intake times, and reduced hospital stays.
  • At a median follow-up of 48 months, stone recurrence and recurrent cholangitis rates were comparable between the groups.

Conclusions:

  • Robotic-assisted laparoscopic surgery (RLS) is a safe and feasible option for complicated hepatolithiasis.
  • RLS offers significant benefits over open surgery (OS), including reduced intraoperative blood loss, fewer transfusions, and faster postoperative recovery.
  • RLS demonstrates comparable efficacy to OS in stone clearance and long-term outcomes.